EXPERT REACTION: Giant step forward for spinal cord injury recovery

Embargoed until: Publicly released: 2018-11-01 05:00

Three people with spinal cord injuries can walk again with the help of targeted electrical stimulation and intense physical therapy, with some leg movement possible even without the stimulation, report European researchers. In a comment piece, a US researcher says previous electrical stimulation techniques have allowed patients some movement, but most don't allow patients to retain control over their movements once the stimulation stops, suggesting in these patients the technique is actually helping to heal the nervous system around the injury. In another paper, the study authors suggest previous electrical stimulation attempts were less effective because they messed with the patients’ perception of where their limbs were.

Journal/conference: Nature, Nature Neuroscience

Organisation/s: Swiss Federal Institute of Technology, Switzerland

Funder: International Foundation for Research in Paraplegia (IRP), Wings for Life, Wyss Center for Neuroengineering, European Union’s Horizon 2020 No.785907 (Human Brain Project SGA2), Eurostars No. E10889, GTXmedical, National Center of Competence in Research (NCCR) Robotics of the Swiss National Foundation, the Commission of Technology and Innovation Innosuisse
(CTI) No. 25761.1, Voirol Foundation, Firmenich Foundation, Pictet Group Charitable Foundation, Panacée Foundation, riders4riders, SOFMER (to P.S.), the Whitaker International Scholars Program (to I.S.) and the H2020-MSCACOFUND- 2015 EPFL Fellows program (No. 665667 to F.B.W.).

Media Release

From: Springer Nature

Spinal cord stimulation restores walking in humans

Three patients with spinal cord injuries are able to walk again with targeted electrical stimulation of the spinal cord, reports a paper published this week in Nature. These results establish a technological framework to improve neurological recovery after spinal cord injuries.

Spinal cord injuries disrupt communication within the nervous system, leading to the loss of essential neurological functions and paralysis. Epidural electrical stimulation (EES) — stimulation applied to the spinal cord — restores locomotion in animal models of spinal cord injury, but is less effective in humans for reasons that have remained unclear.

Grégoire Courtine and colleagues administered targeted EES to three male patients with chronic spinal cord injury (sustained more than four years previously) and partial or complete lower-limb paralysis. Motor neuron activation maps and simulated models were used to identify the optimum patterns of stimulation to different muscle groups. The EES was delivered by a pulse generator controlled in real-time via wireless communication, and was timed to coordinate with intended movement. Within a few days of starting treatment, patients progressed from stepping on a treadmill to supported walking on the ground (while receiving EES), and were able to adjust their step elevation and stride length. Eventually, patients could walk for up to one hour on the treadmill with EES. Following rehabilitation, the three patients could walk independently (either partially supported or with a walker) with EES, and regained voluntary leg movements without EES.

In an associated Nature Neuroscience paper, the same authors demonstrate that previous stimulation protocols to restore walking may have been less effective as they interfered with the patients’ perception of limb position. Stimulation in bursts promotes locomotion while preserving sensory signals coming from the legs.

In an accompanying Nature Neuroscience News & Views article, Chet Mortiz said: “This most recent pair of papers from the Courtine group clearly demonstrates the bright future for the treatment of spinal cord injury.”

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Bryce Vissel is Roth Fellow and the Director of the Centre for Neuroscience and Regenerative Medicine at University of Technology, Sydney

This is extraordinary research, with significant implications for patients.

Work being undertaking at the Centre for Neuroscience and Regenerative Medicine (CNRM) at the University of Technology Sydney is directed to further develop and implement electrical stimulation (EES) to patients with spinal cord injury to bring about unprecedented recovery from spinal cord injury.

Spinal cord injury has devastating consequences. In many cases, patients lose not only the ability to voluntarily move their arms and legs, but they also lose control of many body functions that are essential for life, including loss of bowel, bladder, sexual and temperature control functions.

This new technology, called 'electrical stimulation', is bringing unprecedented recovery of function from spinal cord injury previously thought incurable. The first laboratory to report this was Professor Edgerton’s laboratory at UCLA. Gregoire Courtine previously worked with Professor Edgerton. In this exciting paper, Gregoire’s laboratory now reports an important further advance. Essentially, by precisely regulating the electrical stimulation protocol in an innovative way, patients involved in this study achieved even greater improvement in ability to move voluntarily. They went from a state of complete paralysis to having the ability to walk voluntarily with only the assistance of a stabilising device for safety.

This is exceptional work, part of an ongoing development of this technology initially reported by Professor Edgerton and his team out of UCLA. The future for individuals with spinal cord injury is now, in many cases, likely to be very bright. The technology is not yet approved by regulatory bodies and as we go forward to ensure the technology is optimised for safety and benefit, patients can have real hope, if not expectation, that in a realistic time frame, they could benefit from technology such as this, depending on the state of their injury."

Additional notes from Bryce:

The Centre for Neuroscience and Regenerative Medicine (CNRM), led by Professor Bryce Vissel, at the University of Technology Sydney (UTS), is in the final stages of establishing a program directed to developing and applying electrical stimulation technology, similar to that described in this research, for patients with spinal cord injury in Australia and the Asia Pacific.

This study, from the laboratory of Gregoire Courtine, just now published in Nature and in NatureNeuroscience, reports the use of epidural electrical stimulation (EES) to patients with spinal cord injury to bring about unprecedented recovery from spinal cord injury, previously thought impossible. Professor Vissel can provide detailed insight into the research described in this important paper, as well as describing its implications, history, and its potential for almost immediate impact on spinal cord injury patients in Australia and in the Asia Pacific.

A note on the Asia Pacific Program run out of UTS:

The spinal cord injury research program at UTS’s Centre for Neuroscience and Regenerative Medicine (CNRM), led by Professor Bryce Vissel, is directed to transform the lives of individuals affected by spinal cord injury in Australia and surrounding regions, through a multi-disciplinary medical research program involving engineering, science and medicine.

This effort is in addition to the UTS CNRM's efforts directed to create internationally transformational programs in mental health and neurological diseases such as dementia and Parkinson’s disease. UTS has invested heavily in developing the infrastructure for this program.

Professor Vissel considers it inevitable that the technology will lead to transformational outcomes for individuals affected by spinal cord injury. The technology not only restores movement but it restores functions such as bladder, bowel, sexual function and body temperature control that is usually lost after injury.

The spinal cord research program at UTS is being developed with Professor Reggie Edgerton, who was the first to report that the use of electrical stimulation to the spinal cord can lead to profound recovery of individuals affected by spinal cord injury.

Gregoire Courtine who led the current study in Nature and Nature Neuroscience, previously worked with Professor Edgerton. Professor Edgerton has now been recruited to CNRM to assist in leading the spinal cord injury recovery research program at UTS, through further advancing and ultimately rolling out similar technology.

Last updated: 31 Oct 2018 3:08pm

Declared conflicts of interest:

None declared.

Professor Robert M.I. Kapsa is a Principal Fellow Bionics and Head of Research Neurosciences at the University of Melbourne and St Vincent's Hospital in Melbourne

It has long been known that electrical stimulation can lead to repair of damaged nerves and reconnection via stimulating growth of axons (the connective 'arms' of each nerve cell).

Applied to damaged spinal cord repair, this has potential to promote at least some restored function and the published work reflects some specific instances in which this appears to have been the case.

It is important to note that all spinal cord injuries are different and it is highly likely that not all injuries will respond with equal levels of success. Likewise, it is highly likely that, whilst this approach is relevant to fresh injuries, it may be less effective in existing established injuries that have been stabilised long term.

Nevertheless, this work presents a significant step towards establishing a viable approach towards restored function in at least a proportion of people with spinal cord injuries who would otherwise face long-term confinement in a wheelchair.

Last updated: 31 Oct 2018 3:05pm

Declared conflicts of interest:

None declared.

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